TUESDAY, Dec. 18 (HealthDay News) -- While cardiovascular disease (CVD) death rates in the United States are declining, the illness is still the leading cause of death in the nation, according to the American Heart Association.

Controlling heart disease risk factors remains a major challenge for many people, according to the American Heart Association's Heart Disease and Stroke Statistics -- 2008 Update, published online Dec. 17 in the journal Circulation.

CVD -- which includes heart disease, stroke, high blood pressure, heart failure and several other conditions -- has been the leading cause of death in the United States every year since 1900, with the exception of 1918, when there was a worldwide flu pandemic, the AHA noted.

In 2004, the most recent year for which final data was available, the age-adjusted CVD death rate in the United States was 288 people per 100,000, compared with 307.7 per 100,000 in 2003, the report said. In 2004, CVD was listed as the underlying cause of death in 869,724 deaths, compared to 911,163 deaths in 2003.

Cancer was the second leading cause of death, claiming 553,888 lives in 2004. When looked at separately from other cardiovascular diseases, stroke was the third leading cause of death, claiming 150,074 lives.

While CVD deaths appear to be decreasing, rates of many CVD risk factors are remaining the same or increasing, the report said. For example, rates of overweight and obesity in adults and in children have been rising for several decades. The report found that 66 percent of American adults are overweight, and 31.4 percent are obese. It also found that 17 percent of youngsters ages 12 to 19 are overweight, along with 17.5 percent of children ages 6 to 11, and 14 percent of children ages 2 to 5.

Poor dietary habits -- such as insufficient consumption of fruits and vegetables -- are contributing to overweight and obesity, the report warned. It cited U.S. Centers for Disease Control and Prevention data from 2005 that showed that only 21.4 percent of male high school students and 18.7 of female high school students reported eating at least five daily servings of fruits and vegetables.

Other 2005 data from the CDC revealed that fewer than one in three adults eat fruit two or three times a day, and only 27.2 percent eat vegetables two or more times per day.

Smoking, which increases the risk of coronary heart disease by two to three times, is another highly prevalent CVD risk factor. More than 46 million American adults are daily smokers, and about 4,000 people ages 12 to 17 begin smoking every day, the report said.

It also noted that the United States has increasing rates of diabetes, a major cardiovascular risk factor. It's estimated that the prevalence of diabetes in the United States will more than double between 2005 and 2050.

"Although we have made some substantial strides in understanding the causes of cardiovascular disease, the data in this publication show that we have a long way to go to capture people's attention and to implement the prevention and treatment programs we need," Dr. Donald Lloyd-Jones, one of the report authors and an associate professor in the department of preventive medicine at Northwestern University's Feinberg School of Medicine in Chicago, said in a prepared statement.

The report included good news about improvements in the quality of hospital care for CVD patients. A study of 159,168 heart failure patients treated at 285 U.S. hospitals during 2002-2004 found improvements in clinical outcomes and in the number of patients receiving counseling at discharge, smoking cessation counseling, prescription of beta blockers, and assessment of left ventricular function.

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